HIV death rates have declined significantly since the introduction of new antiretroviral drugs, but they remain disproportionately high for African Americans, according to a new study published in the Archives of Internal Medicine.

The differences between racial groups - and between individuals with differing educational levels - suggest that some Americans are still not getting adequate access to treatment, the study's authors say.

'There have been substantial declines in HIV death rates, but not everyone has benefited equally from the drugs that have been available since 1996,' Edgar Simard, the study's lead author and a senior epidemiologist at the American Cancer Society in Atlanta, told Reuters.

The study analyzed the HIV-related deaths of 91,307 white, African American, and Latino individuals between the ages of 25 and 64 in 26 states to determine how gender, race, and socioeconomic level influenced death rates.

The researchers also divided their studies into two time periods, 1993-95 and 2005-07. This allowed them to take into account the development and use of new 'highly active antiretroviral therapy' (HAART) drugs, which came into use in the early 2000s.

DISPARITIES PERSIST
Overall HIV death rates fell for most groups, the study found. The most pronounced decline in HIV-related deaths was noted in groups that started out with higher death rates in the 1990s.

Researchers took education level as representative of socioeconomic class, so among the most educated black men, those with 16 or more years of schooling, death rates declined from about 118 per 100,000 men in the mid-1990s to about 15 per 100,000 in the mid-2000s.

For the most educated white men, the decline was smaller, but their death rate was much lower to start with. It fell from about 26 deaths per 100,000 to about two per 100,000.

On the other hand, statistics for the least educated black men and women - those who completed 12 or fewer years of schooling - were far less encouraging.

Over the time periods examined by the study, HIV death rates among the least educated black women remained essentially the same at around 27 to 29 deaths per 100,000 women. For the least educated black men, rates fell from about 122 deaths per 100,000 to about 53 deaths per 100,000.

While death rates for the poorest black men fell by more than half, the authors noted, they are still higher than rates among the poorest white men in the 1990s.

Disparities between the most and least educated people have gotten worse, the study says, while African American men and minority women, especially those who are poor, as the people who are most at risk for HIV-related death.

That may be because they don't know they have HIV, don't know about HIV medications, or they lack access to the health care system, researchers said.

THE TASK AHEAD
Dr. William Cunningham, who wrote an editorial accompanying the study, said there needs to be further research targeting vulnerable populations to determine how to get them into treatment and encourage them to stay with it.

'We need the knowledge. We need to know what to do. It's the same approach we use for everything else. ... We know it works, so we follow it. If we don't know how to change it, then we're just grasping in the dark,' Cunningham told Reuters.

Jennifer Kates, vice president and director of global health and HIV policy at the Kaiser Family Foundation in Washington, D.C., who was not involved in the study, said future treatment efforts should be concentrated on populations that now lack access to care.

'[The findings] suggest that it's really those that have the least amount of access who are really worst off, and our efforts need to target those people,' she said.

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